Against Depression

My friend Sean has had arthritis since he was 17. His own body turned on itself, and has crabbed his joints and crippled his movements. The bones in his spine are too chalky to hold him up. His knuckles twist like old tree roots, and he can’t hold a book. He’s allergic to most pain medication, and the wet Irish winters warp his joints even more. It’s got so bad that a few years ago, in his middle forties, he had to retire from the work he was born to do in order to stay at home and nurse the pain.

When we’re talking, he often has to stop and go somewhere else in his mind. That’s when his face takes on a rigid cast, and while I wait for him to come back I can see the lines that suffering has drawn. They’re different from the usual laughing, talking, and frowning lines. These ones come from holding still, not from moving. He can’t stay in one position for long, and sometimes, when it’s very bad, he’s short with the three children whom he adores.

Arthritis isn’t who he is. It isn’t what he talks about, unless he’s asked. Only rarely does he pick morphine over lucidity, and apart from those moments when pain demands every scrap of his attention, he has great time for the world (as he’d say himself). For the buzz of Stephen’s Day at the races, he’ll make the private bargain of a week of extra suffering. For an eighty-mile car journey to see his granny, he sets aside three or four days payment in a currency only he can exchange. If he can’t sit through the whole school musical to see his daughter play Sandra Dee, he coaches himself to sit for twenty minutes.

When he was a teacher, he knew every twelve-year-old’s love interest, and it mortified us and drove us mad. But he also knew our fears and fights, and watched out for us. He still does. He likes to do things for people; quietly, if he can.

Arthritis isn’t who he is, and yet I’d guess his close relationship with suffering has given him a sense of the riptides that pull others down. A way of listening, maybe, or a different strain of patience. A curiosity about the places he won’t get to see, or the experiences his disease has put on a shelf he can’t reach. Whatever the quality, it has won and kept him dozens of friends, from three years old to ninety. And never for a moment, I believe, has any one of us thought the price he has paid for that extra layer of understanding was worth it. Not a minute of that pain.
When the book Listening to Prozac came out, more than a decade ago, I didn’t read it. I imagined it was Dr. Feelgood propaganda, pushing cosmetic pharmacology to smooth the imperfections that brow lifts and bleaching trays hadn’t yet fixed. Then last winter I picked up a copy in the free bin outside Dog Eared Books on Valencia Street.

Peter Kramer had been practising as a psychiatrist for several years when Prozac came on the market. When the first round of long-term patients proclaimed themselves “better than well” after just a few weeks on this new medication, he had to take another look at his life’s work. What did it mean to be well? What did it mean when people said they finally felt like their “real selves”–selves they had never known before? And what did this new class of drugs tell us about older therapies and old-fashioned forbearance?

For ten years after he published this meditation on mental illness and the nature of reality, whenever Kramer spoke publicly, someone would stand up and say “Ah, but what if Van Gogh had Prozac?” You know the type. Bluff, backslapper, heavily invested in his man-in-the-street wisdom, enjoying his moment of contrarianism as long as he’s safe in the love of the crowd. The guy who always thinks his old question is new. The guy who doesn’t care about the answer.

Kramer’s follow-up polemic, Against Depression, is his answer to a question that he came to see as callous. In the decade since his first book, medical researchers have found evidence to move depression from mood disorder squarely into the category of disease. It causes visible, irreversible damage to the brain cells. It eats at the blood vessels and attacks the heart. It causes bone loss. It’s cyclical, and if left untreated, it gets much worse over time. Depression costs more days off work than backache. In its most obvious health consequence–suicide–depression kills more people annually than war and murder combined. And we now know that, like diabetes, it’s probably behind many of the coronary and other deaths that are recorded as something else.

Depression is no joke.

And yet, we seem to be taken with it. We believe it confers special abilities, and we like to keep those gifted sufferers suffering for our art. We want to hold onto depression’s associations with creativity and sensitivity. Some are even drawn to the miasma that fogs around depressives–a smile that’s rare is an addictive reward, especially for men. It makes the tough feel gentle, and the adequate feel powerful.

Stil, depression is also a disease for someone else. If you’re not a pale beauty made to lean on a strong arm, or an artist already consigned (or free) to live outside the range of normal, it’s best to keep it quiet. It’s been decades since people whispered about “The Big C,” but as Dooce notes, a diagnosis of depression is enough to make insurance companies deaf, employers leery, and near-strangers eager to judge what this says about you and your parents. To counter the weakness, laziness, and unreliability that’s otherwise implied, we’re now careful to stress that it’s “just a chemical imbalance”–nothing to be ashamed of. Declaring it “organic,” a body illness, also seems to matter: we rehabilitate depression by dragging it out of the realm of moral failure and into the flesh.

In Japan, a society that can be startlingly cruel, the public health authorities refused to recognize depression, in spite of the world’s highest rate of suicide. Glaxo-SmithKline, a drug company, had to step in and name it. In their ads they delicately explained it as “a cold in the soul,” and they opened the first-ever crisis hotline for people who had never realized their despair and failure might have a cause.

“Everyone’s depressed. It’s all diet. People need more bananas and broccoli,” someone advised me, when they spotted the Kramer book in my bag. Soon after that, I watched a BBC sports interviewer interrogate a Belfast footballer about his leave of absence for depression. “Many people would look at you and say, fabulous success, plenty of money, crowd adulation–in essence, what have you got to cry about?” he asked. He actually said that. I try to imagine the same interviewer asking Lance Armstrong what on earth he had to have testicular cancer about.

We cherish it.
We dismiss it.
We despise it.

Why, Peter Kramer asks, don’t we hear demands to eradicate depression, as we tried to eradicate smallpox, polio, and tuberculosis? Why no gray ribbons, no sponsored treadmill rides, no spokesmodels or survivor bracelets for this low-key killer that chews up many millions more lives than, say, leukemia or breast cancer?

I knew more about depression than most. I’d sat up through the night listening to despairing people on a suicide hotline. I’d seen people close to me live with it–and I do mean live, black jokes and all. I’d read Andrew Solomon’s fat book, The Noonday Demon. Somehow all that unfelt knowledge left me with the belief that if you could get out of bed (even if you’d slept in your clothes), you weren’t depressed. That paralyzing quality, described so often, was one I took literally.

I, on the other hand, wasn’t sick at all last winter. I was just failing and flailing. In fact, I would have liked to have been sick–confined to bed with some mysterious, painless illness that would have let me sleep for a long time and see no one. I thought about that a lot. And I thought about crawling under my desk at work, or into my wardrobe at home. The dark, the hidden, and the confined were the only inviting spaces left. Under my desk, I wouldn’t have to worry about leaking tears, or looking people in the eye, or inspiring my clients to greatness.

A few months before, I’d found things funny. Skipped and sang on Bernal Hill. Turned annoyances into dramatic stories. Said yes to invitations. Now, before meetings, I wrote “BREATHE” on the inside of my left wrist, because I kept tamping down stale air in my lungs instead of letting it out. Then it escaped in windy sighs that I couldn’t hold in any more than sneezes. I walked slowly, hoarding energy. I planned my day to avoid people. At night I would fall into bed in my clothes, as early as I could, only to wake wide-eyed at four in the morning, chased by mean, looping thoughts like a rabbit on a dogtrack.

Have you ever almost really hurt yourself? A badly-judged left turn that makes a truck honk, or a vault off your bike that could have smashed your skull? The knee-shaking shot of hormones that wires your whole body after a near-miss is permanent in depression. At that dosage, cortisol is poison. Every scrap of energy gets diverted to survival. Every fiber twitches: danger–fight or flight? It looks like sloth, but it feels like war.

I felt like I would break, but only kind words cracked me. Luckily, when you’re depressed, you can throw human kindness off the scent: that frowning, sighing slump dries up the cheerful greetings and sends friends away. It must be like being very old, or very ugly. Without the respite of an illness or a convent, I crawled through day after day in which I was an unfit employee, girlfriend, daughter, sister, and friend. My mind plunged into pointless, terrifying rants that came packaged as reality, revealed at last. Life is ugly. No one will help. No one could help. Help with what?

Like rheumatoid arthritis, depression turns your own body against itself. It chews not on your cartilage, but on your brain cells and your sense of reality. It’s as seductive as a wife-beater, shutting out other voices to turn itself into your only friend. The only one who tells the truth about the bleakness of the world. All your energy goes towards getting through whatever stands in your way–struggling, slogging, pushing, through work and small talk and getting food–whatever it is you have to get through until you can be alone again with the voice who can be trusted. As Harvey Fierstein says, depression wants to get you alone in a room so it can kill you.

And the last thing it feels like is an illness. No, this monumental, world-swallowing suckage sits outside you: it comes from the project, the job, the love affair, the city, the family, or the decade. For me, these low cycles have always led me to abrupt life changes. It’s a kind of shock therapy: uprooting jobs, careers, friendships, romances, and countries. Those shifts feed the craving for anonymity and reinvention, and they leave behind the shame of a condition that breeds shame.

When I was eight years old I got glasses for the first time. When I looked out the window, I could see each blade of grass, crisp and bright and distinct, where before there had been a soft green blur. That day I looked at everything, and said hello to all the small things. It was amazing, that all this had been there all along.

Getting better from depression was like that. Missing dimensions popped back up. Plain old normal days tasted crisp and delicious. And then there were the bittersweet replays, when I traveled through the previous months and years, and counted all I’d misheard, misfelt, and missed. Depression isn’t noble or interesting; it’s monotonous, self-absorbed misery that leaves little room for art or kindness or other people.

I’m back, I wanted to shout last spring, that hunched crone was a changeling, not me! I wanted to learn how to get better without running from the site of misery; how to return to people who hadn’t realized I’d been away, how to apologize for someone who wasn’t me. I would have liked some scars to point to, to explain my absence. It was shocking, in a way, this drug-borne proof that I’m an animal, washed with chemical tides, turning seasons, light, and food into moods. When you reduce my suffering to a curable disease; to symptoms, postures, and intonations, I’m no longer especially special. All those causes for my sadness fluttered down like snotty Kleenex. And in that tender state, on that hopeful, nervous journey back, I was humbled to be met with warm arms rather than cold shoulders–because yes, they’d known I was away.

It’s been more than a year since I got sick, and eight months since I got better. Every day I think of the scientists who mashed up rat brains to create the drugs that brought me back to life, and I’m grateful. And I wish more people could shuck that hollow shell.

I’m here via Bbrug. I too suffered just as you described it. And I thought something else was causing how I felt. And I tried all kinds of things to make myself feel better initially. And then I sunk into it. Finally I diagnosed myself (no one else would or could) and after a few years of sliding into the depression, I took a pill and felt normal. I had forgotten what normal felt like and once I had the contrast readily at hand, I could see what the problem was. Now I know when I’m sliding and I can nip it in the bud. It’s a little like learning when to stop drinking before you get impaired. Practice! I really liked your comparison with Lance Armstrong’s cancer and I plan to shamelessly use it whenever I talk to people about depression, which I am no longer afraid to do. Thank you for a great post.

Dervala, arrived here from a link from the OpenCoffee Limerick folks. I understand you’ll be joining them on Thursday. Wish I could be there to meet you, but I’m headed back to the States to visit family. I’m an emigrant in the opposite direction from you, living in Ireland. Anyway, just wanted to say that this piece on depression is incredibly beautiful. You’ve put into wonderful words a concept that’s pretty tough to describe to anyone who hasn’t been there. Enjoy your visit in Limerick, hope we can connect at some point.